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NPI Code Detail

MEDICARE: STAN GOTTLIEB

MEDICARE:   STAN  GOTTLIEB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist025894NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1025894OTHERNYPHARMACIST

General Provider Information

NPI Number : 1487771770
Entity Type Code : Individual
Provider Name (Legal Business Name) : STAN GOTTLIEB
Provider Business Mailing Address
First Line : 26910 GRAND CENTRAL PKWY
Second Line : APT 31D
City : FLORAL PARK
State : NY
Zip : 11005-1045
Country : US
Telephone Number : 718-631-1317
Fax Number :
Provider Business Practice Location Address
First Line : 26910 GRAND CENTRAL PKWY
Second Line : APT 31D
City : FLORAL PARK
State : NY
Zip : 11005-1045
Country : US
Telephone Number : 718-631-1317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ STAN GOTTLIEB ” Practice Location

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